Provider Demographics
NPI:1326135666
Name:BEATTY, DANA L (CNM CERTIFIED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:L
Last Name:BEATTY
Suffix:
Gender:F
Credentials:CNM CERTIFIED NURSE
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:L
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:16801 ELLIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473
Mailing Address - Country:US
Mailing Address - Phone:773-616-8929
Mailing Address - Fax:
Practice Address - Street 1:500 EAST 51ST STREET
Practice Address - Street 2:PROVIDENT HOSPITAL OF COOK COUNTY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2400
Practice Address - Country:US
Practice Address - Phone:312-572-1200
Practice Address - Fax:312-572-1294
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife